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Clinical Auditor

Job Description

Supports goals, contract, and accreditation requirements of health plan in conducting reviews of clinical interactions and clinical documentation including reviews of case management, utilization management, vendor, and provider records. Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting. Interacts with multiple stakeholders internally and externally. Conducts staff audits, process audits and pre-delegation and delegation activities. Results of the audits are discussed with appropriate leadership and trainings are developed/edited in conjunction with the training team to identify for individuals and/or for unit learning gaps.

Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for vendors, providers, UM staff and case managers.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

Job Details

Locations

Job Category

Job Type

Contract

Job Reference

R00000027246

Company

Magellan HRSC, Inc.

Date Posted

Tuesday, July 2, 2019

EEO Statement

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”

Haita Makanji VP of Clinical Strategy and Programs at Magellan MRx

EEO Statement

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

WARNING: Employment Scam

It has come to our attention that individuals are contacting potential candidates, falsely claiming to be representatives of Magellan Health offering work at home positions. Magellan Health does not interview any candidate through email, nor do we request banking information in the interview process or issue checks to candidates to set up home offices. Our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.

If you suspect you’ve been contacted by someone falsely claiming to be a representative of Magellan Health, please call 1-410-953-2911, M-F, 9 am – 5 pm, EST, to report it.